POA/SDM Determining Transport Destination
Question# 862
Can a person with power of attorney (POA) make a destination decision when a bypass is clinically approved? I recently encountered a situation where an elderly Pt who could not make decisions on their own had experienced trauma that fit the trauma bypass criteria, but the POA who was on-scene requested the nearest hospital. POA's have the authority to make life and death decisions, does this apply to/supersede our destination transport guidelines?
Answer:
For your awareness, bypass agreements are not set out by the RPPEO. The MOH sets the foundation of these agreements which are then mutually agreed upon between your paramedic service and the hospitals. This is why each paramedic service may have slightly different bypass agreements with distinct hospitals in their catchment areas.
In the situation you describe, it is recommended to include the SDM/POA in the conversation and goals of care and educate them on the patient's condition and why a particular bypass/hospital may be the most beneficial for them. It is crucial that the patient and SDM/POA are well-educated and can make an informed decision on what is best for the patient given all the necessary information. Remember, you are the clinical expert, not them and they may be making an uninformed decision during this high stress situation. Informed consent applies to all aspects of care, including patient disposition.
If after you have provided them with all the information and they are still requesting transport to the closest facility, they do ultimately have the right to refuse transporting on a trauma bypass or to a specific hospital, in which case you would document this just as you would anything else (refusal of a particular treatment or medication). That said, you could always try phoning a friend (BHP) to see if they can speak to the SDM/POA and advise them on what is in the best interest for the patient. Sometimes hearing it from a physician or someone else in general may just do the trick. At the end of the day, a patient centered approach is key, and the closest hospital may be better than them refusing transport and staying home altogether.
Ultimately, as you may be aware, patients and SDM/POA, or anyone else for that matter cannot just dictate which hospital they wish to go to via ambulance as there are several factors that come into play such as, ambulance levels on the road, CTAS, CACC, vehicle movements, PPS, bypasses, location, etc. You can certainly put the request in with CACC on what hospital is preferred by the patient and/or family however, you may have to contact your superintendent as it is not always feasible.
In the situation you describe, it is recommended to include the SDM/POA in the conversation and goals of care and educate them on the patient's condition and why a particular bypass/hospital may be the most beneficial for them. It is crucial that the patient and SDM/POA are well-educated and can make an informed decision on what is best for the patient given all the necessary information. Remember, you are the clinical expert, not them and they may be making an uninformed decision during this high stress situation. Informed consent applies to all aspects of care, including patient disposition.
If after you have provided them with all the information and they are still requesting transport to the closest facility, they do ultimately have the right to refuse transporting on a trauma bypass or to a specific hospital, in which case you would document this just as you would anything else (refusal of a particular treatment or medication). That said, you could always try phoning a friend (BHP) to see if they can speak to the SDM/POA and advise them on what is in the best interest for the patient. Sometimes hearing it from a physician or someone else in general may just do the trick. At the end of the day, a patient centered approach is key, and the closest hospital may be better than them refusing transport and staying home altogether.
Ultimately, as you may be aware, patients and SDM/POA, or anyone else for that matter cannot just dictate which hospital they wish to go to via ambulance as there are several factors that come into play such as, ambulance levels on the road, CTAS, CACC, vehicle movements, PPS, bypasses, location, etc. You can certainly put the request in with CACC on what hospital is preferred by the patient and/or family however, you may have to contact your superintendent as it is not always feasible.
References
BLS PCS 3.4
Published
20 December 2024
ALSPCS Version
3.4
Views
66
Please reference the MOST RECENT ALS PCS for updates and changes to these directives.